Comparison of tramadol and tramadol/droperidol mixture for patient-controlled analgesia

Abstract

MBCKB FRCA FFARCSI MRcv(UK) l~I-IlCa/vl(Anaes)To compare the analgesic efficacy and side effects of tramadol vs tramadol and droperidol for post-operative patient-controlled analgesia (PCA), Method: Randomised, double-blind study. Thirty-four patients undergoing elective colorectal or head and neck surgery were allocated to Group I (n = 18, PCA bolus I 0 mg tramadol ) or Group 2 (n = 16, PCA bolus I 0 mg trarnadol + 0. I mg droperidol). Anaesthesia was induced with fentanyl and thiopentone and maintained with O 2, N20 plus enflurane or isoflurane with iv morphine at doses decided bythe attending anaesthetists. Muscle relaxal~on was achieved with atracurium or vecuronium. Patients were observed four-hourly for pain using an I l-point verbal rating scale (VRS). Nausea and vomiting, and sedation were assessed using four-point scales post-operatively. V~I signs, request for rescue anti-emetic and analgesic, and overall satisfaction were recorded. ~ults: The mean nausea scores were lower in Group 2 (I.00 • 1,33 vs 0.06 • 0.25 at 0-8 hr, 1.22 _+ 1.93 vs 0.06 + 0.25 at 8-16 hr, P < 0.01; 0.81 • 1.68 vs 0 at 32-40 hr, P < 0.05; Group 1 vs Group 2). The vomiting scores were also lower (0.50 • 1.04 vs 0 at 0--8 hr, 0.67 __ 1.50 vs 0 at 8-16 hr, P < 0.05; Group I vs Group 2). Seven (3996) patients in Group I, but none in Group 2 requested rescue anti-emetic (P < 0.01). There were no differences in VRS, sedation score, overall satisfaction or vital signs. Conclusion: Tramadol and droperidol combination is superior to tramadol alone for post-operative PCA. It provides a similar quality of analgesia with less nausea and vomiting and without an increase in sedation.Objeclif: Comparer le tramadol seul avec rassodation tramadol-clropEndol sous l'aspect de l'efficadtE et des effets secondaires lorsque administr~s pour ranalgEsie postop&atoire autocorCw61Ee (PCA). M~hodes : l~tude alEatoire en double aveugle. Trente-quatre patients soumis ~ une chirurgie Elective colorectale ou cEphalo-cervicaie ont ErE assignEs au groupe I (n= 18, PCA avec tramadol I0 mg en bolus) ou au groupe 2 (n = 16, PCA avec t~-~lol I 0 rag+ drop&idol 0, I m 8 en bolus), l'anesthEsie induite au fentanyl et au thiopentone Etait maintenue avec OJN20 et enflurane ou isoflurane et morphine/v aux doses d&idEes par l'anesthEsiste en charge. La curadsation Etait rEalisEe avec de ratracudum ou du v&uronium. AprEs rintervention, la douleur a EtE cotEe aux quatre heures sur une ckhelle verbale simple (EVS) en onze points. Les nausEes les vomissements et la sedation ont EtE estimEs sur une &helle de quatre points. Les signes vitaux, les demandes d'anti&r~tiques et d'analgEsiques, et le degrE g~n&ai de satisfaction Etaient notes. Rksultalx = Les scores moyens de nausEe Etaient infEdeurs darts le groupe 2 (I ,00 _ 1,33 vs 0,06 • 0,25 ~ 0-8 h ; 1,22 _+_ 1,93 vs 0,06 • 0,25 ,~ 8-I 6 h, P < 0,01 ; 0,81 • 1,68 vs 0 ,~ 32-40 h. P < 0,05 ; groupe I vs groupe 2). Les scores de vomissement ~taient aussi infEdeurs (0,50 _• 1,04 vs 0 ~ 0-8 h, 0,67 + I ,S0 vs 0 ~ 8-16 h, P < 0,05, ...

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

“…namic adverse effects have been reported with tramadol alone or with the tramadol-droperidol combination. [1][2][3]12,16,18 We observed a decrease in blood pressure and heart rate from the tenth minute onwards only in the tramadol-clonidine group. This decrease did not require any intervention and no such adverse effect was detected in the other groups.…”

“…Studies using tramadol and tramadol-droperidol combinations found no significant sedation, 2,3,9,16,18 while all studies using clonidine have reported a prominent increase in sedation. 1,4,10,15,19 This leads us to believe that the significant increase in sedation observed in the tramadol-clonidine group was due to the addition of clonidine.…”

“…Sedation was monitored on a four-point scale (Table I) 15 and nausea was monitored on a four-point scale (Table II). 16 The onset time of analgesia, duration of analgesia and total tramadol dose were recorded. The onset time of analgesia was defined as the time required to decrease the VAS score control value by 20 mm, and duration of analgesia as the increase of VAS score value by 20 mm.…”

“…D Di is sc cu us ss si io on n Mean onset time of analgesia has been reported as 10-15 min for epidural tramadol and 5-11 min for the tramadol-droperidol combination. 2,16,18 Furthermore, it has been stated that a combination of clonidine with fentanyl, sufentanil and morphine decreases the onset time of analgesia by 50%. 4,19,20 Consistent with previous reports, the present study shows that the onset time of analgesia was 16 min time with tramadol alone and that this time decreased to approximately eight minutes when either clonidine or droperidol was added.…”

“…2,9,16 It has been suggested that the combination of clonidine with an opioid extends the duration of analgesia by two to three times. 1,4,10,15,21 Murthy et al 22 have found a lower volume of distribution for epidural tramadol and stated that the half-life was shorter than with iv usage.…”